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Pharm Kay Exam 2 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

etiologies of hypothyroidism

A

hashimoto
thyroidectomy
RAI therapy

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2
Q

what drug replaces T4

A

Levothyroxine

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3
Q

what drug replaces T3

A

Liothyronine

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4
Q

what was synthroid made from

A

ground thyroid glands of cows [ew]

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5
Q

are all levothyroxine drugs on the market bio equivalent?

A

yes

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6
Q

MOA of levothyroxine

A

active compound= T3–then converted FROM T4 by deiodination in liver & peripheral tissues

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7
Q

how much levothyroxine is absorbed in the small intestine

A

80%

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8
Q

1/2 life of levothyroxine

A

7d

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9
Q

how many wks before steady state w/ levothyroxine

A

4-6wks

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10
Q

where should levothyroxine be stored?

A

out of heat,light or humidity

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11
Q

how should levothyroxine be taken?

A

empty stomach before breakfast

or 4hrs after last meal

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12
Q

what is the most important factor with taking levothyroxine

A

consistancy in timing of dose

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13
Q

dose adjustment when switching PO–> IV

A

decrease by 50%

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14
Q

how long till SE of levothyroxine go away?

A

2-3wks

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15
Q

what should we look at if we have a pt on a levothyroxine dose >300

A

adherence
malabsorption
drug interactions

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16
Q

avg. dose for adult *full replacement

A

1.6mcg/kg/d

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17
Q

avg. dose for elderly *full replacement

A

0.5mcg/kg/d

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18
Q

what pt population needs to start levothyroxine on a lower dose?

A

cardiac pts

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19
Q

how should we dose obese pts on levothyroxine?

A

w/ their lean body wt dosage

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20
Q

what do we monitor for levothyroxine dose?

A

TSH

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21
Q

what is 3 situations would warrant TSH checking

A

new symptoms
drug interaction w/ T4
pregnancy

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22
Q

what pt’s have TSH’s that are misleading

A

central hypothyroidism d/t hypothalamic or pituitary dz

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23
Q

ADR of levoyhrxoine

A 
palpitation
tremor
anxiety
wt loss
tachycardiac
increase # poops
osteoporosis
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24
Q

what pts are @ risk for cardiac complications (arrythmia, AMI, ACS) on levothyroxine?

A

cardiac dz

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25
Q

how does levothyroxine cause ACS or dysrhythmia in HF pts

A

it increase HR and contractility–which increases myocardial O2 demand

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26
Q

what drugs decrease effects of LT4?

A 
amiodarone
PTU
Antacids
Carbamazepine
Phenytoin
Rifampin
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27
Q

if on levothyroxine when should you take antacids, bile acid resins, fiber, Calcium/iron?

A

@ a different time b/c it affects absorption

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28
Q

what drugs inhibit T4–>T3 conversion

A

amiodarone

PTU

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29
Q

what drugs increase LT4 metabolism via cyps

A

carba
pheny
rifampin

30
Q

name of pure T3

A

liothyronine

31
Q

what has a shorter 1/2 life levo or liothyroine?

A

liothyronine

32
Q

when would you prescribe Liotrix?

A

pts who cannot convert T4–>T3

33
Q

what is Liotrix made of?

A

T3 and T4

34
Q

what is the problem w/ thyroid USP?

A

levels of T3 and T4 vary ALOT

35
Q

why do some patients like desiccated thyroid meds?

A

b/c they get a lift off the fast acting T3, all in their heads (sorry pts)

36
Q

common causes of hyperthyroidism

A

graves
multinodular goiter
autonomous nodule
thyroiditis

37
Q

what are the 3 definitive tx options for hyperthyroidism (not all drugs)

A

thionamides
RAI
surgery

38
Q

what is a adjunctive tx options for hyperthyroidism?

A

b-blockers

Steroids

39
Q

what are the 2 thionamides we use?

A

propylthiouracil

Methimazole

40
Q

MOA of thionamides

A

inhibit thyroid hormones synthesis by interfering w/ thyroid peroxidase–mediation iodination of tyrosine residues in thyroglobulin

41
Q

what thionamide do we prefer?

A

methimazole

42
Q

why do we like methimazole

A

Qday
effective @ low dose
major ADR= rare

43
Q

when do we use PTU

A

life-threatening thyroid-storm

pregnancy

44
Q

what happens if methimazole is taken during pregnancy

A

aplasia cutis

esophageal atresia

45
Q

how does dosing look for thionamides?

A

start high–then lower once symptoms are controlled (start lowing 4-8wks in)

46
Q

how long till partial clinical resolution of thyrotoxicosis?

A

2 wks

47
Q

what pts reach remission @ 12-18monthS

A

small goiter
low levels of anti-TSH ab
mild/mod hyperthyroidsm

48
Q

fraction of pts on monotherapy of thionamide that reach remission

A

1/3

49
Q

what is the recurrent rate of hyperthyroidism

A

50%

50
Q

ADR of thionamides

A

arthralgias
Rash
Gi intolerance
agranulocytosis

51
Q

what joint problem can develop from thionamide use

A

anti-thyroid arthritis syndrome

52
Q

what rheum condition is PTU associated w/

A

ANCA + vasculitis w/ other symptoms

53
Q

if a pt on thionamides presents w/ fever, sore throat, mouth ulcers what should you get? why?

A

CBC w/ diff

agranulocytosis!!!

54
Q

what can PTU possibly cause in the liver

A

acute hepatic failure

55
Q

what do we use for RAI of the thyroid

A

sodium Iodide I-131

56
Q

how does Sodium Iodide I-131 work?

A

thyroid gland takes it up–then it release Beta particles to cause a slow inflammatory response that destroy the thyroid

57
Q

what should you try prior to RAI

A

thionamides

58
Q

main ADR of RAI

A

radiation thyroiditis–lower neck pain

59
Q

use of B-blockers in hyperthyroid

A

decreases symptoms of increased adrenergic tone

60
Q

once hyperthyoridism resolves what can we do w/ b-blockers

A

taper down

61
Q

what steroid do we use in hyperthyroidism

A

dexamethasone

62
Q

how does dexamethasone help w/ hyperthyroidism

A

PREVENTS peripheral conversion of T4–>T3

63
Q

how does hypothyroidism affect a fetus

A 
increase risk of:
miscarriage
pre-term birth
LBW
fetal brain development
64
Q

what do we need to do to levothyroxine dose in pregnancy

A

increase (25-30%)

65
Q

should you take pre-natals and levothyroxine @ the same time of day?

A

no

66
Q

can we use desiccated thyroid or lio in pregnancy?

A

no–not enough T4 gets to fetal brain

67
Q

when can a pregnant woman resume her levothyroxine dose?

A

after delivery

68
Q

what can uncontrolled hyperthyroidism cause in a fetus?

A 
increase risk of:
miscarriage
gest. HTN
pre-term
pre-eclamp
HF
thyroid-storm
IUGR
premature
still born
69
Q

thionamide used in 1 trimester pregnancy

A

PTU

70
Q

thionamide used in 2/3 trimester and breast feeding

A

methimazole

Pharm Kay Exam 2 (3 decks)

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